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Biomedical subjects

M Björck

Publications and source records attributed to M Björck.

At least 19 recordsLinked to original sources
PubMed2006

Fatal bleeding following delivery: a manifestation of the vascular type of Ehlers-Danlos' syndrome.

INTRODUCTION: The vascular form of Ehlers-Danlos' syndrome (type IV) is a potentially lethal genetic condition because of rupture of major arteries, often in the peri-partum period. CASE REPORT: We report a 31-year-old primipara who died from a rupture of the right subclavian artery. The patient had several symptoms and signs typical of the disease. The rupture occurred during the expulsion-phase of delivery but was recognized only on day 9. CONCLUSION: Early recognition is crucial to avoid maternal mortality due to this genetic disorder. Once the condition is suspected, the clinical diagnosis is straightforward.

Adult↗
PubMed2006

Incidence and risk of venous thromboembolism in patients with verified arterial thrombosis: a population study based on 23,796 consecutive autopsies.

BACKGROUND: The relationship between atherothrombotic disease and venous thromboembolism (VTE) remains unclear. PATIENTS AND METHODS: In a cohort of 23,796 consecutive autopsies, performed using a standardized procedure and representing 84% of all in-hospital deaths between 1970 and 1982 in an urban Swedish population, we investigated the relationship between verified arterial thrombosis and VTE, with the hypothesis that patients with thrombosis in major artery segments have increased odds of VTE. RESULTS: We found an increased risk of VTE in patients with arterial thrombosis (Odds ratio; OR adjusted for gender and age 1.4, 95% confidence interval; CI 1.3-1.5) (P < 0.001). Patients with cervico-cranial and peripheral artery thrombosis had an excess risk even when controlling for age and major concomitant diseases. A negative association between coronary thrombosis and VTE in the univariate analysis (OR 0.7; 95% CI 0.6-0.8) (P < 0.001), was less pronounced in the multivariate analysis (OR 0.8; 95% CI 0.7-1.0) (P = 0.016). CONCLUSIONS: A positive association between atherothrombosis and VTE was confirmed, except in patients with coronary thrombosis, where IHD as competing death cause is a possible confounder. Our findings indicate a potential for directed prevention, but may also imply similarities in etiology.

Aged↗
PubMed2006

Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm.

OBJECTIVES: To investigate the importance of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), based on the December 2004 consensus definition, on outcome after surgery for ruptured abdominal aortic aneurysm (rAAA). METHODS: Twenty-seven patients underwent open surgery for rAAA after the introduction of intra-abdominal pressure (IAP) measurements among patients at risk of IAH. Case-records were reviewed retrospectively. Seventeen patients underwent IAP-monitoring. RESULTS: Of eight patients with IAP <21 mmHg none developed colonic ischaemia or ACS. Of four patients with IAP 21-25 mmHg (IAH grade III), two underwent colonic resection. One patient treated with open abdomen died from cardiac arrhythmia. Five patients had IAP >25 mmHg (IAH grade IV). All developed ACS. Two were not decompressed and both developed pulmonary complications, one died. Two underwent colonic resection and one was treated with open abdomen, all three survived. Of 10 patients not monitored for IAP, one died of cardiac complications, but no patient developed signs of colonic ischaemia or ACS. Mortality at 30 days and 1 year was 3/27 (11%). CONCLUSION: IAH and ACS were common among patients undergoing surgery for rAAA. The ACS consensus definition seems appropriate in this clinical context. Monitoring IAP, and timely decompression of patients with IAH might improve outcome after surgery for rAAA.

Abdomen↗
PubMed2006

Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors.

OBJECTIVES: To estimate the incidence and extension of visceral organ infarction, and to evaluate potential causes, in patients with autopsy-verified nonocclusive mesenteric ischaemia (NOMI) and transmural intestinal infarction. SETTING: In Malmö, Sweden, the autopsy rate between 1970 and 1982 was 87%, creating possibilities for a population-based study. DESIGN: Amongst 23 446 clinical autopsies, 997 cases were coded for intestinal ischaemia in a database. In addition, 7569 forensic autopsy protocols were analysed. In a nested case-control study within the clinical autopsy cohort, four NOMI-free controls, matched for gender, age at death and year of death, were identified for each fatal NOMI case to evaluate risk factors. RESULTS: The overall incidence of autopsy-verified fatal NOMI was 2.0/100,000 person-years, increasing with age up to 40/100,000 person-years in octogenarians. Patients with stenosis of the superior mesenteric artery (SMA; n = 25) were older (P = 0.002) than those without (n = 37), and had more often a concomitant stenosis of the coeliac trunk (P < 0.001). Synchronous infarction in the liver, spleen or kidney occurred in one-fifth of all patients. Fatal cardiac failure [OR 2.9 (1.7-5.2)], history of atrial fibrillation [OR 2.2 (1.2-4.0)] and recent surgery [OR 3.4 (1.6-6.9)] were risk factors for fatal NOMI. CONCLUSIONS: Fatal heart failure was the leading cause of intestinal hypoperfusion, although stenosis of the SMA and coeliac trunk, atrial fibrillation and recent surgery contributed significantly. Collaboration across specialties seems to be of utmost importance to improve the prognosis.

Age Distribution↗
PubMed2005

Long-term results of above knee femoro-popliteal bypass depend on indication for surgery and graft-material.

UNLABELLED: OBJECTIVE To determine the long-term results of above-knee femoro-popliteal bypass with autologous saphenous vein (SV) or expanded polytetrafluoroethylene (ePTFE) in routine surgical practice. METHODS: Data from the Swedish vascular registry, Swedvasc, was reviewed retrospectively. Patients with bypass surgery in 1996 and 1997 were assessed 5-7 years later. Data were gathered from the case-records and from clinical follow-up. The composite endpoint of graft failure included death within 30 days, occlusion, major amputation, extension of the graft to below-knee position and removal of an infected graft. Kaplan-Meier curves and Cox' proportional hazard ratios were calculated. RESULTS: Four hundred and ninety-nine patients undergoing bypass for critical limb ischemia (CLI) (56%) or claudication (44%), SV (28%) or ePTFE (72%), were included. There were no significant differences in patient characteristics between patients with SV or ePTFE. CLI and ePTFE were risk factors for graft failure. For patients with both claudication and CLI SV grafts yielded better long-term results than ePTFE grafts ( p <0.03) and ( p <0.003), respectively. Symptom aggravation after graft occlusion was almost exclusively restricted to ePTFE grafts. CONCLUSIONS: Femoro-popliteal bypass above-knee with SV gives good long-term results, especially for claudication. ePTFE grafts cannot be recommended in claudicants, since occlusion occurs often and frequently leads to CLI.

Adult↗
PubMed2004

D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery.

BACKGROUND: There is no accurate non-invasive method available for the diagnosis of acute thromboembolic occlusion of the superior mesenteric artery (SMA). The aim of this study was to assess the diagnostic properties of the fibrinolytic marker D-dimer. METHODS: From September 2000 to April 2003 consecutive patients aged over 50 years admitted to hospital with acute abdominal pain were studied. Patients with possible acute SMA occlusion at presentation had blood samples taken within 24 h of the onset of the pain for analysis of D-dimer, plasma fibrinogen, activated partial thromboplastin time, prothrombin time and antithrombin. The value of D-dimer testing to diagnose SMA occlusion was assessed by means of likelihood ratios. RESULTS: Nine of 101 patients included had acute SMA occlusion. The median D-dimer concentration was 1.6 (range 0.4-5.6) mg/l, which was higher than that in 25 patients with inflammatory disease (P = 0.007) or in 14 patients with intestinal obstruction (P = 0.005). The combination of a D-dimer level greater than 1.5 mg/l, atrial fibrillation and female sex resulted in a likelihood ratio for acute SMA occlusion of 17.5, whereas no patient with a D-dimer concentration of 0.3 mg/l or less had acute SMA occlusion. CONCLUSION: D-dimer testing may be useful for the exclusion of patients with suspected acute SMA occlusion.

Abdominal Pain↗
PubMed2004

Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery--a population-based study.

OBJECTIVE: To determine the incidence of acute thrombo-embolic occlusion of the superior mesenteric artery (AOSMA) in a population-based study. MATERIAL: All clinical (n=23,446) and forensic (n=7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000-230,000 inhabitants). The autopsy rate was 87%. METHODS: Calculation of the incidence of AOSMA with intestinal gangrene in those autopsies coded for bowel ischaemia (997/23,446 clinical and 9/7569 forensic autopsies). The operative procedures performed in 1970, 1976 and 1982 were also analysed. RESULTS: Two forensic and 211 clinical autopsies demonstrated AOSMA with intestinal gangrene. Previous suspicion of intestinal ischaemia was noted in only 33%. Sixteen patients were operated. The cause-specific mortality was 6.0/1000 deaths. The incidence was 8.6/100,000 person years, increasing exponentially with age (p<0.001). Mortality was 93%. CONCLUSIONS: The incidence and mortality of AOSMA is higher than previously reported from clinical series. There is seldom any suspicion of the diagnosis prior to death.

Adult↗
PubMed2003

Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population.

OBJECTIVES: to characterize the clinical presentation of patients with acute thrombo-embolic occlusion of the superior mesenteric artery (SMA). DESIGN: prospective study. MATERIALS: twenty-four consecutive patients admitted to Blekinge County Hospital, Karlskrona, Sweden, with acute thrombo-embolic occlusion of the SMA, over a three-year period from April 1999 through March 2002. METHODS: clinical data were registered prospectively. Incidence, diagnostic procedures and factors associated with survival were analysed. RESULTS: the diagnosis was verified at operation in 20, and at autopsy in 4 patients. The incidence was 5.3 per 100 000 inhabitants per year. Among the 20 patients with embolic disease, atrial fibrillation was present in 95%, synchronous embolic events in 30% and warfarin treatment in 10%. D-dimer was elevated on admission in 13/13. Four patients were diagnosed at first consultation. Fifteen underwent curative revascularisation (6) or bowel resection only (9). Five were alive at one-year follow-up, of whom one had short bowel syndrome. Length of bowel ischaemia predicted institutional (p = 0.004) and one-year mortality (p = 0.005). CONCLUSIONS: the incidence was higher than expected. Embolic occlusions predominated. Old age, atrial fibrillation, severe abdominal pain and synchronous embolus suggest the diagnosis of acute bowel ischaemia. Length of bowel ischaemia predicted outcome.

Acute Disease↗
PubMed2002

Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs.

BACKGROUND: Laparoscopic living donor nephrectomy is increasingly being performed, although the effects of carbon dioxide pneumoperitoneum (CO2 PP) on renal function and hemodynamics and the levels of vasopressin are not well studied. METHODS: Renal blood flow, renal venous pressure, urine output, and vasopressin concentrations in renal venous blood were measured in pigs subjected to 12 mmHg of CO2 PP for 150 min. RESULTS: Renal blood flow was decreased at induction of PP and increased during the first 30 min after exsufflation. Renal venous pressure was increased during PP. There was indirect evidence of a decrease in urine output during PP. No changes in renal venous vasopressin concentrations were seen. CONCLUSION: A CO2 PP of 12 mmHg causes changes in renal hemodynamics and urine output. No changes in vasopressin levels were seen in this pig model, suggesting that other explanations for the observed changes must be sought.

Animals↗
PubMed2002

Revascularization of the superior mesenteric artery after acute thromboembolic occlusion.

BACKGROUND: The outcome and prognostic factors after revascularization of acute thromboembolic occlusion of the superior mesenteric artery (SMA) are poorly documented. METHODS: Sixty patients with acute thromboembolic occlusion of the SMA had revascularization procedures at 21 hospitals from 1987 to 1998. They were registered prospectively in the Swedish Vascular Registry. Patient files were analysed retrospectively. RESULTS: The median age of the patients was 76 years; 73 per cent suffered from cardiac disease and 23 per cent had previous vascular surgery. Onset of symptoms was classified as sudden (30 per cent), acute (33 per cent) or insidious (37 per cent). The occlusions were thought to be either embolic (67 per cent) or thrombotic (33 per cent). The diagnosis was suspected on first examination in 32 per cent of patients, a group whose median time to operation was shorter (P = 0.01). Fifty-eight patients had an exploratory laparotomy and subsequent revascularization, and two were treated with thrombolysis alone. Second-look laparotomy was performed in 41, and third look in eight patients; 19 required an additional bowel resection. The overall mortality rates were 43, 52, 60 and 67 per cent at 30 days, discharge, 1 and 5 years, respectively. No patient was dependent on intravenous nutrition after 1 year. Previous vascular surgery resulted in a higher institutional mortality rate (79 per cent; P = 0.02). Patients who had a sudden onset of symptoms outside hospital had a better outcome (mortality rate 27 per cent; P = 0.02). CONCLUSION: Many non-diagnostic radiological examinations were performed and a routine second-look is warranted. The results suggest that attempts at revascularization procedures for acute mesenteric ischaemia may improve the outcome.

Adult↗
PubMed2002

Measuring the abdominal aorta with ultrasonography and computed tomography - difference and variability.

OBJECTIVES: The aim of this study was to estimate the agreement between ultrasonography (US) and computed tomography (CT) in the measurement of aortic diameter in subjects with and without abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: Sixty-one subjects were investigated, 33 with a diameter >30mm and 28 with a diameter <30mm. Difference and variabily anteroposterior (AP) and transverse (TR) diameters were analysed. RESULTS: In non-aneurysmal aortas US gave larger AP: 2.8mm (95% CI 1.7-4.0) and TR: 3.8mm (2.3-5.3) diameter. In AAAs the mean diameter did not differ significantly. In non-aneurysmal aortas we expect 95% of differences to be <5.7mm in AP and <7.6mm in TR measurements. In aneurysmal aortas we expect 95% of differences to be <8.0mm in AP and <10.6mm in TR measurements. CONCLUSION: The difference and variability between US and CT varies depends on the diameter of the aorta and how it is measured. These differences have importance for clinical practice and for research.

Aged↗
PubMed2001

Preliminary study of D-dimer as a possible marker of acute bowel ischaemia.

BACKGROUND: Occlusion of the superior mesenteric artery (SMA) demands prompt recognition and diagnosis. No accurate diagnostic method is available. The aim of this study was to determine whether the fibrinolytic marker D-dimer is a useful early marker of acute bowel ischaemia. METHODS: Fourteen patients suspected of having acute bowel ischaemia were analysed for an increase in plasma D-dimer level. RESULTS: Six patients had embolic or thrombotic occlusion of the SMA and all had significantly higher D-dimer levels than those without thromboembolic occlusion (P < 0.05). Four patients with strangulation of the small bowel due to adhesions and one with a ruptured aortic aneurysm also had raised D-dimer values. CONCLUSION: In patients with suspected thromboembolic occlusive disease of the SMA, a raised level of D-dimer indicated the presence of acute bowel ischaemia, whatever the cause. A more extensive prospective study is needed to evaluate a potential survival benefit using the test as a marker of the need for urgent laparotomy.

Aged↗
PubMed2001

Influence of diagnostic criteria on the prevalence of abdominal aortic aneurysm.

PURPOSE: We studied the prevalence of abdominal aortic aneurysm (AAA) in a population with high incidences of cardiovascular diseases and analyzed how the prevalence varies according to methodology and criteria. METHODS: All men and women aged 65 to 75 years who lived in the Norsjö municipality in northern Sweden were invited to undergo an ultrasound scanning (US) examination. Those with an aortic diameter of 28 mm or more or with poor visibility on US were examined with computed tomography scanning (CT). Various recommended AAA definitions, two diagnostic methods (US and CT), and two diameters (maximum and anteroposterior) were analyzed. RESULTS: Of 555 people invited to participate in the study, 504 accepted (248 men and 256 women; 91%). Eight subjects had undergone surgery for an AAA. Ninety-two subjects underwent CT. The mean maximum infrarenal aortic diameter was 24.6 mm (by means of US). Depending on diagnostic criteria, the AAA prevalence was 3.6% to 16.9% in men and 0.8% to 9.4% in women. Depending on which previous study was used as a comparison and the definition of AAA and diagnostic technique used, the prevalence in this study was 1.3 to 4.0 times higher for men and 2.0 to 5.8 times higher for women. CONCLUSION: In a region in which residents have a high risk for cardiovascular disease, we found the highest prevalence of AAA ever reported within a population. The prevalence highly depends on methodology and diagnostic criteria, with a 10-fold variation. Detailed defined criteria are necessary to permit comparisons between studies: the number of individuals who have undergone surgery for AAA and whether they are included, the prevalence in 5- and 10-year age intervals, attendance rate, visibility, which diameter(s) is measured, and the prevalences with as many as possible of the four described definitions of AAA. The etiology of the high prevalence of AAA in this population needs to be investigated further.

Aged↗
PubMed2000

pHi monitoring of the sigmoid colon after aortoiliac surgery. A five-year prospective study.

OBJECTIVES: to determine whether sigmoid-pHi diagnose colon ischaemia after aortoiliac surgery? DESIGN: single-centre, non-randomised, prospective study. PATIENTS AND METHODS: of 83 patients operated on between 1994 and 1998, 41 with risk factors for the development of colon ischaemia were monitored peri- and/or postoperatively with sigmoid-pHi. Peri-operative mortality was 26% (8/31) after operation for a ruptured abdominal aortic aneurysm (AAA), nil after operation for non-ruptured AAA. Thirty-five postoperative colonoscopies were performed. All non-survivors were examined post-mortem. RESULTS: of six patients developing colon ischaemia after emergency operations (five for ruptured AAA) all had pHi-values <7.1 for 16-80 h. In two patients with transmural gangrene, and who had pHi-values below 6.6, pHi-monitoring permitted early diagnosis, colectomy and recovery. Three patients with mucosal gangrene were treated conservatively and recovered. Nine patients without ischaemic lesions had pHi-values <7.1, during 1-5 h, without adverse outcome. Bilateral ligation of the internal iliac arteries increased the risk of colon ischaemia (p<0.0001). CONCLUSIONS: pHi-monitoring was diagnostic for colon ischaemia. Mucosal and transmural gangrene were distinguished. The importance of the internal iliac circulation was demonstrated. The low mortality rate, and the fact that no patient died from bowel ischaemia, suggests that sigmoid pHi-monitoring may improve survival after ruptured AAA.

Aged↗
PubMed1999

[Intestinal ischemia after abdominal aorta surgery. A dreaded complication surveyed by a combination of different methods].

The article consists of a review of findings in previously published reports on intestinal ischaemia after abdominal aortic surgery. In a combined cohort and case-control study of 2,824 patients from the Swedish vascular registry, the incidence of intestinal ischaemia was 2.8%. The independent risk factors identified were preoperative shock, emergency surgery, renal insufficiency, advanced age, operation at a regional hospital, aortabifemoral grafting, ligation of one or both internal iliac arteries, bleeding > 10 litres, and operating and cross-clamping time. Cardinal symptoms were unreliable predictors. Sigmoidoscopy was potentially diagnostic in 95 per cent of cases. In a clinical study of 34 patients, sigmoid colon pHi was highly predictive of ischaemic colitis and other life-threatening complications. In a por-cine model of ischaemic colitis, blood flow in the superior mesenteric artery, colonic pHi and histological mucosal damage were unaffected by dobutamine.

Aged↗